Defeating Diabetes

Sarah Silverstein

UAB’s Comprehensive Diabetes Center fights every day to get closer to a cure.

Written by Rosalind Fournier

Photography by Beau Gustafson

Sarah Silverstein was 9 years old when she was diagnosed with Type 1 diabetes. No one in her family had ever been confronted with the disease before, and they had no idea what they were up against. “Our lives really changed the day I was diagnosed,” says Sarah, who is the youngest of five. “Being 9 and taking on the responsibility of checking my blood sugar and taking insulin injections multiple times a day was scary. My whole family had a lot to learn.”

A few years earlier, the family of Chelsey LaRussa had gone through the same thing. Reading an article about diabetes, Chelsey’s mom was alarmed to recognize the very symptoms her daughter was having—rapid weight loss, constant thirst, fatigue. “She took me to the doctor, and he sent us to Children’s of Alabama, where I was diagnosed,” Chelsey remembers. “You go immediately into learning about the disease, what it entails and trying to get your health under control. It’s definitely a whirlwind.”

Chelsey’s father, Benny LaRussa, Jr., describes that time as a “real awakening for us as parents, wondering how this would alter Chelsey’s life well into the future.” Sarah’s father, David Silverstein—who describes his daughter, now 25, as “tough as nails and sweet as sugar”—admits he was similarly shocked by his daughter’s diagnosis. “I’m embarrassed to say how little I knew about diabetes,” he says. “I thought it was just, you take your insulin, and that was it.” The more he learned, the more he and his wife, Susan, doubled down on doing all they could to keep their daughter healthy. “My wife made sure every single person in Sarah’s community knew what to do in case of an emergency.”

As it happens, their fathers’ families had known each other for years before either Chelsey or Sarah was diagnosed. They lived in the same community, and Silverstein and LaRussa knew each other professionally. Since they learned they both had daughters with diabetes, however, “all of the sudden we became very close and fast friends,” LaRussa remembers. United against a common enemy, the two fathers—both prominent businessmen as well as community fundraisers—decided that helping their own children cope with diabetes was not enough. They wanted to get involved in any way they could to further diabetes research. Specifically, Silverstein and LaRussa wanted to see the creation of a world-class diabetes research center here in Birmingham that would be considered a leader in the field.

Both involved in the JDRF (formerly known as the Juvenile Diabetes Research Foundation), LaRussa and Silverstein approached the group’s head researcher and asked point blank, LaRussa remembers, “What are the chances of UAB being one of the top research institutions JDRF supports?” The researcher told them in detail about the kind of institutional commitment they look for when making contributions, and the men took that straight to UAB with unbridled determination to convince the leadership this was the right thing to do.

Their discussions and subsequent fundraising efforts ultimately led to the creation in 2008 of the UAB Comprehensive Diabetes Center, an interdisciplinary center that performs cutting-edge research while training future clinicians and researchers. The center’s goals, which are being realized every day, are to develop new and better treatments while working toward the ultimate brass ring—a cure for diabetes.

No one was more awed by Silverstein and LaRussa’s efforts to make that happen than their own daughters. “Since the day I was diagnosed, my dad has done whatever he can to try and find a cure for me and for all the people out there who have this disease,” Sarah explains. “It means the world to me, and because of him, I feel like we’re one step closer to finding a cure from his efforts.”

Chelsey echoes those sentiments. “Sarah and I are so fortunate to have such caring fathers,” she says. “It makes you feel so warm inside for somebody to care so much that they will do all they can do in order to provide the best research and resources in Birmingham to help find a cure.”

Chelsey LaRussa

People living with diabetes will tell you that while many, including Sarah and Chelsey, learn to cope relatively well, the uncertainty and daily concerns never go away. The work it takes to stay healthy can make young people feel they’ve been robbed of part of their childhood, while those diagnosed as adults feel their lives have been turned upside down.

And while their families and doctors understand it all too well, outside of those directly impacted, diabetes often doesn’t look as serious and challenging as other diseases that tend to get more attention. “There are so many people out there who just have no idea,” Sarah says. “Unless they experience it firsthand, I don’t think people will know unless the word is spread about what it’s like living with this disease.”

At its core, diabetes is characterized by the body’s inability to properly regulate the amount of sugar in the blood. The two major forms are Type 1 and Type 2, and what they share in common are damaged or destroyed beta cells, which reside in the pancreas and play a key role in producing, storing, and releasing insulin. The risks of complications are high—including vision loss, kidney failure, and stroke.

Those are the basics of the science. What it actually means for patients is easier to understand. “No matter what treatments are available or how well you work to manage it, you never know what you’re going to wake up to and what your day is going to be like when you have diabetes,” Sarah explains. “And that’s scary. I go to sleep thinking about my blood sugar, and I wake up and that’s the first thing I think about.” She and Chelsey describe constant interruptions in their days—whether they’re in class, meetings, or just sitting down to send an email—due to blood-sugar emergencies. It can severely affect their moods, making them uncharacteristically angry when their blood sugar is too high or unable to think clearly when it’s low.

There are good days and bad days. Sarah describes one of the bad days—which occurred just recently—of living with diabetes. “Most of the day I was able to monitor my blood sugar, but into the night it dropped severely low,” she remembers. “I woke up around 2 a.m. and realized I had had a seizure. And the only reason I’m alive today is that my siblings were there and called the paramedics.”

She says in the 16 years since her diagnosis, it’s the first time that’s ever happened. “You always think you’re doing your best and you’re able to manage your diabetes, but that experience opened my eyes again to the fact that you can’t take anything for granted.”

Early on, a major coup for the Comprehensive Diabetes Center was bringing in Dr. Anath Shalev to lead the center—an effort in which both Silverstein and LaRussa were actively involved. Originally from Switzerland, Shalev earned her medical degree and a post-graduate scholarship in experimental medicine at prominent universities there. She then completed a research fellowship at Harvard, eventually finishing her training as a research fellow in endocrinology, diabetes, and metabolism at the National Institutes of Health. She then started her own diabetes research program and rose through the faculty ranks at the University of Wisconsin-Madison.

She was in a prominent position, but in UAB and its new diabetes center Shalev saw an opportunity to “have more impact on diabetes than just doing my own research in my own little lab,” she explains. She was impressed by the coming together of community leaders as well as UAB and Children’s of Alabama to make the Comprehensive Diabetes Center become a reality. She also emphasizes importance of seeing doctors and researchers from different disciplines joining forces here to fight the disease and its associated complications. “We have members representing nine different schools and several departments on campus,” Shalev says of the Comprehensive Diabetes Center team. “They pretty much span the whole spectrum of research and biology, which is really exciting. Those interactions and cooperation can lead to much greater advances than if everyone worked for themselves in their own little corners.”

As a physician and research scientist, Shalev’s work is world-renowned, but she’s also very much driven by the human side of the disease. “While diabetes is treatable, patients will tell you it’s not really about the pain of the injections or that type of thing—it’s having to think about it 24/7 for the rest of their lives,” she says. “It’s a hard thing for other people to understand.”

Doctors like Shalev and her colleagues have made life-changing progress in improving treatments and overall health of patients—progress that couldn’t be more timely, given that diagnoses of diabetes have grown to epic proportions. Alabama is now considered part of the country’s “Diabetes Belt” as one of six states with a diabetes rate greater than 10 percent.

Still further complicating the issue is that doctors and patients can no longer rely on the terms “juvenile diabetes” or “adult onset” to differentiate between what we now call simply Type 1 or Type 2 diabetes. That’s because young people are increasingly being diagnosed with Type 2 diabetes, and the opposite is also true. “Adults can still develop Type 1 diabetes,” Shalev explains, noting that one newly diagnosed patient was 84 years old. “Because they’re adults, they’re misdiagnosed as Type 2, so they’re not given insulin right away, which creates a very dangerous situation. So we’re trying right now to educate the medical community about that.”

Dr. Anath Shalev

These trends only increase the urgency to develop better treatments and pathways toward a cure, and to that end, Silverstein, LaRussa, their daughters, and everyone else vested in the Comprehensive Diabetes Center’s success believe the center is living up to its promise. (About a decade ago—as their own girls were beginning to approach 18—they also helped initiate the creation of a transition clinic, which is a collaboration between Children’s and UAB to help patients transition from pediatric care to managing the disease as an adult.)

Shalev states that one focus of the current research involves getting at the disease by attempting to save and strengthen existing beta cells in patients with diabetes—the same cells that had been considered all but unsalvageable. “We previously observed and new research has shown that people even after decades of Type 1 diabetes still have some beta cells—and with that some insulin production—intact,” explains Shalev. “It’s not enough to maintain normal blood sugar levels, but enough that it’s measurable. Can we find ways to promote the survival of these cells and maybe even expand them, providing an environment where beta cells can grow and function more normally? Those questions have initially guided us in the direction we’ve taken, and I’ve seen several groups now trying to do the same thing.” Meanwhile, Shalev’s long-term efforts have now started to be translated into patient care, and UAB recently received a $2.1 million grant from the JDRF for a new clinical trial to see if a common blood-pressure drug, verapamil, can promote beta-cell survival, as it has been shown by the Shalev lab to do in animal models. In addition, an active drug discovery program is ongoing to identify novel compounds that will help enhance the patient’s own functional beta-cell mass. By targeting the underlying cause of the disease, these exciting breakthroughs could transform treatments for both Type 1 and Type 2 diabetes.

The Comprehensive Diabetes Center has now grown to have 213 faculty members, bringing their own groups and research projects into the fold and further increasing the center’s visibility and prestige. “Our people are publishing in top-tier journals,” Shavel notes. “Our members are invited to present at large conferences including the American Diabetes Association, and we regularly invite top specialists to come and present to us and even have started to host national meetings. We have a yearly UAB Diabetes Research Day where we invite speakers from outside who see our institution and get to know us. And last fall we were selected as only one of five centers worldwide to be part of the Human Islet Research Network, focusing on beta-cell regeneration.”

The Silverstein and LaRussa families continue to stay abreast of and actively promote the work being done at the UAB Comprehensive Diabetes Center. Silverstein and Larussa continue to serve on the community advisory board for the center. Meanwhile, Shalev recently took Sarah on a tour of the facilities. “The type of research they’re doing makes me hopeful I might not have to worry so much about my own children having the disease,” she says.

Sarah says it still breaks her heart when she hears of someone’s child being diagnosed with diabetes, but she’s glad to have some positive news to share. “I always try to tell them about how supportive this community is and what excellent doctors there are here in Birmingham,” she says. “I think that if more people knew about the Comprehensive Diabetes Center and the work they’re doing downtown in our own community, they would be utterly amazed.”

Both Sarah and Chelsey are now engaged to be married, excited about the future, and hopeful that a cure will be found within their lifetimes. Like Sarah, Chelsey is always trying to spread the word about the work being done in Birmingham on diabetes research that is so personal to her and her family. “I have been fortunate in that I’ve been able to get the care I need and that I’m so well managed,” she says. “But there are so many people who aren’t that way, and that’s what motivates me to speak and try to raise awareness for everyone who struggles with this—they all deserve the best treatment and, hopefully, a cure one day.”